Is Trendelenburg Truly Best Practice for Hypotension?

Nurses General Nursing

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Hello! I'm currently a senior nursing student getting my PALS and ACLS certifications, and am hopeful to be placed in an ICU capstone next spring. It got me wondering about the effectiveness of the Trendelenburg position in cases where CPR is necessary and if such practices are executed in hospitals today.

I've researched this topic a bit, due to seeing two sides of the coin but still remain a bit confused. I can rationalize the use of the Trendelenburg position for the following reasons:

-Natural force of gravity to drain venous return from the lower periphery to increase ECV

-Increase O2/blood flow to the brain, which would be very important in cases of a destabilizing patient to prevent residual brain damage.

However, I read by someone in a forum that some research says something different such as:

-Putting a patient in Trendelenburg actually pushes the intestinal viscera upon the diaphragm and may cause obstructions to certain airways/capillaries

-Research has seen worse outcomes in patients treated with Trendelenburg compared to supine positions.

I'm also wondering if a Trendelenburg would make it more difficult for blood to leave the brain, causing a pooling effect that can not be pumped back out due to V fib or other contractility issues. Also, if the blood pools and therefore clots, could a patient have a stroke secondary to putting them in a Trendelenburg at such a time?

Thanks so much for any input on the matter. I would just like to make sure that I can do everything possible for my client should they destabilize, as such emergencies need immediate attention to increase rates of survival and I want to be competent should I be faced with such a scenario.

Specializes in CRNA, Finally retired.

Trendelenburg is voodoo and I haven't seen it done in years (except to get surgical access). You've done a good job of listing the reasons. The only exception is using it for a short time when inserting central lines.

Fluids and vasopressors will get you a lot further. The only time I use it is to get big people pulled up in the bed.

Specializes in Emergency Room, Trauma ICU.

I've never seen a pt put in trendelenberg for CPR. I can't see it being helpful.

Specializes in Critical Care.

Aside from a long list of adverse effects, it doesn't even do what it intends to do and often only makes the problem worse; it "tricks" baroreceptors and results in poorer perfusion, not better perfusion. It's a popular topic in any "busted nursing myths" article.

http://www.aacn.org/WD/CETests/Media/C1123.pdf

The only time I see it used currently is to pull a patient up in bed and to help engorge the jugular veins for IJ insertion.

AHA doesn't teach it as part of the ACLS curriculum. Trendelenberg is an old sacred cow that's not supported by evidence, and aside from fooling the baroreceptors, it only succeeds in making patients very uncomfortable.

Subee is right: it's voodoo.

Specializes in critical care.

I had a jerk anesthesiologist put me in trendelenberg before a cesarean. I was crazy anxious about the procedure. He placed the spinal, which never actually worked, and suddenly I could feel my BP was bottoming out. I told him I could tell it was dropping, and he kept telling me I was just fine, until finally he had an "oh, bleep" moment, bolused me with fluids and dropped my head down. Not sure if it did much good. I actually asked him to put me under at that point because we'd been waiting for the spinal to work for nearly 30 minutes by then and I was tired of feeling that anxious. That was in 2010, so some do still do it.

The only thing we use trendellenberg for is to scoot someone larger up in the bed (save our backs, use gravity). It is my facility's policy NOT to trendellenberg for hypotension as (others have said) the sudden pressure on the baroreceptors in the brain or neck trick the brain into thinking blood pressure is higher than it is.

Specializes in ICU.

Stopped doing it years ago, but apparently some educators still teach it, because I have seen new nurses do it and claim they were taught to in nursing school.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Trendelenberg is NOT useful in CPR...ever....as long as I have been a nurse it has never been taught for CPR. For a patient that feels faint...lying them down does just as much good as trendelenberg.

Trendelenberg is used for inserting lines to engorge the jugular or subclavian veins.

The Current Slant on the Trendelenburg Position

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